Consultation on the dietary management of moderate malnutrition

Organized by WHO (Departments of Child and Adolescent Health and Development and Nutrition for Health and Development) in collaboration with UNICEF, UNHCR, WFP and supported by the IASC Nutrition Cluster

30 September to 3 October 2008, Geneva, Switzerland

Moderate malnutrition (MM) is defined as a weight-for-age between -3 and -2 z-scores below the median of the WHO child growth standards. It can be due to a low weight-for-height (wasting) or a low height-for-age (stunting) or to a combination of both. Similarly, moderate wasting and stunting are are defined as a weight-for-height and height-for-age, respectively, between -3 and -2 z-scores.

MM affects many children in poor countries. Children with moderate malnutrition have an increased risk of mortality and MM is associated with a high number of nutritionrelated deaths. If some of these moderately malnourished children do not receive adequate support, they may progress towards severe acute malnutrition (severe wasting and/or oedema) or severe stunting (height-for-age less than -3 z-scores), which are both life-threatening conditions. Therefore, the management of MM should be a public health priority.

In contrast to severe malnutrition, programmes for the management of MM in children have remained virtually unchanged for the past 30 years, and it seems timely to review efforts to improve their efficacy and effectiveness.

Objectives

General Objectives:

To identify areas of consensus on the nutrient needs and dietary management of MM in children that can be translated into evidence-based global guidelines.

To identify knowledge gaps that should be addressed by research, both in the area of dietary management and the modalities for providing that diet.

Specific objectives:

To provide an estimate of nutritional requirements of children with MM (defined by a weight-for-age less than -2 z-scores). These nutritional requirements will be examined separately for children who are moderately wasted and those who are stunted.

To examine if current approaches for MM management, based either on dietary counseling
or on the provision of food supplements, provide all nutrients needed for the recovery of children with MM.

To formulate recommendations to improve the dietary management of MM, either through dietary counseling or food supplementation.

In each of these areas, if the evidence base is not strong enough to formulate recommendations, the
meeting should recommend which type of research is needed to address current knowledge gaps.